Abstract
Objectives
A systematic review and meta-analysis was conducted to quantitatively synthesize the current evidence on the association of prenatally diagnosed isolated single umbilical artery (iSUA) in singleton pregnancies with small for gestational age (SGA) neonates and other perinatal outcomes.
Methods
A search of PubMed/Medline, Scopus and The Cochrane Library was conducted, from inception to February 2021, in order to identify studies comparing the risk of SGA and other perinatal adverse outcomes in prenatally diagnosed iSUA singleton pregnancies vs. those with a 3-vessel cord (3VC). The quality of eligible studies was assessed according to the improved Newcastle–Ottawa Scale (NOS). The heterogeneity of results across the studies was tested using the I2 test. Funnel plots and Egger’s test were used to assess the possibility of publication bias. Prospero RN: CRD42020182586.
Results
The electronic search identified 7,605 studies, of which 11 were selected, including three retrospective cohort and eight retrospective case control studies, overall reporting on 1,533 iSUA cases. The risk of delivering SGA neonates was increased in cases with iSUA (OR: 2.90; 95% CI: 2.02–4.18; p<0.00001; I2=71%). Similarly, iSUA was associated with an increased risk of pregnancy-induced hypertension (PIH) (OR: 2.23; 95% CI: 1.41–3.54; p<0.000; I2=1%), intrauterine death (IUD) (OR: 2.62; 95% CI: 1.43–4.79; p=0.002; I2=0%), preterm birth (PTB) (OR: 2.48; 95% CI: 1.73–3.56; p<0.00001; I2=56%), cesarean section (CS) (OR: 1.64; 95% CI: 1.11–2.41; p=0.01; I2=78%) and admission to neonatal intensive care unit (NICU) (OR: 2.28; 95% CI: 1.52–3.44; p<0.000001; I2=73%).
Conclusions
In prenatally diagnosed iSUA there is a higher risk of SGA, PIH, IUD, PTB, CS and NICU admission. These findings support the value of prenatal diagnosis of iSUA, which may subsequently intensify surveillance for the detection of specific pregnancy complications.
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Research funding: None declared.
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Author contributions: Themistoklis Dagklis developed the project, participated in data collection/analysis and the manuscript writing. Antonios Siargkas designed, coordinated, implemented the project, evaluated the results and participated in manuscript writing. Aikaterini Apostolopoulou participated in data analysis and manuscript writing. Ioannis Tsakiridis coordinated the project and participated in manuscript writing/editing. Apostolos Mamopoulos and Apostolos Athanasiadis participated in manuscript editing. Alexandros Sotiriadis participated in manuscript editing and data collection/analysis. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Not applicable.
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Ethical approval: Not applicable.
References
1. Thummala, MR, Raju, TNK, Langenberg, P. Isolated single umbilical artery anomaly and the risk for congenital malformations: a meta-analysis. J Pediatr Surg 1998;33:580–5.10.1016/S0022-3468(98)90320-7Search in Google Scholar
2. Nyberg, DA, Mahony, BS, Luthy, D, Kapur, R. Single umbilical artery. Prenatal detection of concurrent anomalies. J Ultrasound Med 1991;10:247–53. https://doi.org/10.7863/jum.1991.10.5.247.Search in Google Scholar
3. Dagklis, T, Defigueiredo, D, Staboulidou, I, Casagrandi, D, Nicolaides, KH. Isolated single umbilical artery and fetal karyotype. Ultrasound Obstet Gynecol 2010;36:291–5. https://doi.org/10.1002/uog.7717.Search in Google Scholar
4. Chow, JS, Benson, CB, Doubilet, PM. Frequency and nature of structural anomalies in fetuses with single umbilical arteries. J Ultrasound Med 1998;17:765–8. https://doi.org/10.7863/jum.1998.17.12.765.Search in Google Scholar
5. DeFigueiredo, D, Dagklis, T, Zidere, V, Allan, L, Nicolaides, KH. Isolated single umbilical artery: need for specialist fetal echocardiography? Ultrasound Obstet Gynecol 2010;36:553–5. https://doi.org/10.1002/uog.7711.Search in Google Scholar
6. Rembouskos, G, Cicero, S, Longo, D, Sacchini, C, Nicolaides, KH. Single umbilical artery at 11-14 weeks’ gestation: relation to chromosomal defects. Ultrasound Obstet Gynecol 2003;22:567–70. https://doi.org/10.1002/uog.901.Search in Google Scholar
7. Salomon, LJ, Alfirevic, Z, Berghella, V, Bilardo, C, Hernandez-Andrade, E, Johnsen, SL, et al.. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2011;37:116–26.10.1002/uog.8831Search in Google Scholar
8. Mu, SC, Lin, CH, Chen, YL, Sung, TC, Bai, CH, Jow, GM. The perinatal outcomes of asymptomatic isolated single umbilical artery in full-term neonates. Pediatr Neonatol 2008;49:230–3. https://doi.org/10.1016/s1875-9572(09)60016-4.Search in Google Scholar
9. Ebbing, C, Kessler, J, Moster, D, Rasmussen, S. Isolated single umbilical artery and the risk of adverse perinatal outcome and third stage of labor complications: a population-based study. Acta Obs Gynecol Scand 2020;99:374–80.10.1111/aogs.13747Search in Google Scholar PubMed
10. Kim, HJ, Kim, JH, Chay, DB, Park, JH, Kim, MA. Association of isolated single umbilical artery with perinatal outcomes: systemic review and meta-analysis. Obs Gynecol Sci 2017;60:266–73.10.5468/ogs.2017.60.3.266Search in Google Scholar PubMed PubMed Central
11. Xu, Y, Ren, L, Zhai, S, Luo, X, Hong, T, Liu, R, et al.. Association between isolated single umbilical artery and perinatal outcomes: a meta-analysis. Med Sci Mon Int Med J Exp Clin Res 2016;22:1451–9.10.12659/MSM.897324Search in Google Scholar PubMed PubMed Central
12. Luo, X, Zhai, S, Shi, N, Li, M, Cui, S, Xu, Y, et al.. The risk factors and neonatal outcomes of isolated single umbilical artery in singleton pregnancy: a meta-analysis. Sci Rep 2017;7:7396.10.1038/s41598-017-07053-7Search in Google Scholar PubMed PubMed Central
13. Voskamp, BJ, Fleurke-Rozema, H, Oude-Rengerink, K, Snijders, RJ, Bilardo, CM, Mol, BW, et al.. Relationship of isolated single umbilical artery to fetal growth, aneuploidy and perinatal mortality: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2013;42:622–8. https://doi.org/10.1002/uog.12541.Search in Google Scholar PubMed
14. Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, et al.. Meta-analysis of observational studies in epidemiology a proposal for reporting. J Am Med Assoc 2000;283:2008–12. https://doi.org/10.1001/jama.283.15.2008.Search in Google Scholar PubMed
15. Bombrys, AE, Neiger, R, Hawkins, S, Sonek, J, Croom, C, McKenna, D, et al.. Pregnancy outcome in isolated single umbilical artery. Am J Perinatol 2008:25:239–42. https://doi.org/10.1055/s-2008-1061504.Search in Google Scholar PubMed
16. Horton, AL, Barroilhet, L, Wolfe, HM. Perinatal outcomes in isolated single umbilical artery. Am J Perinatol 2010;27:321–4. https://doi.org/10.1055/s-0029-1241732.Search in Google Scholar PubMed
17. Predanic, M, Perni, SC, Friedman, A, Chervenak, FA, Chasen, ST. Fetal growth assessment and neonatal birth weight in fetuses with an isolated single umbilical artery. Obstet Gynecol 2005;105:1093–7. https://doi.org/10.1097/01.AOG.0000158108.51397.f5.Search in Google Scholar PubMed
18. Tülek, F, Kahraman, A, Taşkın, S, Özkavukçu, E, Söylemez, F. Determination of risk factors and perinatal outcomes of singleton pregnancies complicated by isolated single umbilical artery in Turkish population. J Turk Ger Gynecol Assoc 2015;16:21–4.10.5152/jtgga.2015.15115Search in Google Scholar PubMed PubMed Central
19. Mailath-Pokorny, M, Worda, K, Schmid, M, Polterauer, S, Bettelheim, D. Isolated single umbilical artery: evaluating the risk of adverse pregnancy outcome. Eur J Obstet Gynecol Reprod Biol 2015;184:80–3. https://doi.org/10.1016/j.ejogrb.2014.11.007.Search in Google Scholar PubMed
20. Doğan, S, Özyüncü, Ö, Atak, Z, Turgal, M. Perinatal outcome in cases of isolated single umbilical artery and its effects on neonatal cord blood gas indices. J Obstet Gynaecol (Bristol) 2014;34:576–9.10.3109/01443615.2014.919578Search in Google Scholar PubMed
21. Battarbee, AN, Palatnik, A, Ernst, LM, Grobman, WA. Association of isolated single umbilical artery with small for gestational age and preterm birth. Obstet Gynecol 2015;126:760–4. https://doi.org/10.1097/aog.0000000000001037.Search in Google Scholar
22. Li, T-G, Nie, F, Xu, X-Y. Correlation between ductus venosus spectrum and right ventricular diastolic function in isolated single-umbilical-artery foetus and normal foetus in third trimester. World J Clin Cases 2020;8:5866–75. https://doi.org/10.12998/wjcc.v8.i23.5866.Search in Google Scholar PubMed PubMed Central
23. Naveiro-Fuentes, M, Carrillo-Badillo, MP, Malde-Conde, J, Gallo-Vallejo, JL, Puertas-Prieto, A. Perinatal outcomes in singleton pregnancies with a single umbilical artery. J Matern Fetal Neonatal Med 2016;29:1562–5. https://doi.org/10.3109/14767058.2015.1053864.Search in Google Scholar PubMed
24. Hua, M, Odibo, AO, Macones, GA, Roehl, KA, Crane, JP, Cahill, AG. Single umbilical artery and its associated findings. Obstet Gynecol 2010;115:930–4. https://doi.org/10.1097/aog.0b013e3181da50ed.Search in Google Scholar PubMed
25. Khalil, MI, Sagr, ER, Elrifaei, RM, Abdelbasit, OB, Halouly, TAL. Outcomes of an isolated single umbilical artery in singleton pregnancy: a large study from the Middle East and Gulf region. Eur J Obstet Gynecol Reprod Biol 2013;171:277–80. https://doi.org/10.1016/j.ejogrb.2013.09.028.Search in Google Scholar PubMed
Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2021-0260).
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